Forsch Randall T, Little Sahoko H, Williams Christa
University of Michigan Medical School, Ann Arbor, MI, USA.
University of Michigan Medical School, Ann Arbor, Mi, USA.
Am Fam Physician. 2017 May 15;95(10):628-636.
The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Many aspects of laceration repair have not changed over the years, but there is evidence to support some updates to standard management. Studies have been unable to define a "golden period" for which a wound can safely be repaired without increasing risk of infection. Depending on the type of wound, it may be reasonable to close even 18 or more hours after injury. The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves. Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection. Good evidence suggests that local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits. Local anesthetic with epinephrine in a concentration of 1:200,000 is safe for use on the nose and ears. Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas. Wounds heal faster in a moist environment and therefore occlusive and semiocclusive dressings should be considered when available. Tetanus prophylaxis should be provided if indicated. Timing of suture removal depends on location and is based on expert opinion and experience.
裂伤修复的目标是实现止血和达到最佳的美容效果，同时不增加感染风险。多年来，裂伤修复的许多方面并未改变，但有证据支持对标准处理方法进行一些更新。研究未能确定一个伤口可安全修复而不增加感染风险的“黄金期”。根据伤口类型，受伤后18小时或更长时间进行缝合也可能是合理的。与使用无菌手套相比，裂伤修复时使用非无菌手套不会增加伤口感染风险。用可饮用的自来水冲洗而非无菌盐水冲洗也不会增加伤口感染风险。充分证据表明，浓度高达1:100,000的含肾上腺素局部麻醉剂用于手指是安全的。浓度为1:200,000的含肾上腺素局部麻醉剂用于鼻子和耳朵是安全的。组织粘合剂和伤口粘合带可有效用于低张力皮肤区域。伤口在潮湿环境中愈合更快，因此如有条件应考虑使用封闭性和半封闭性敷料。如有指征应进行破伤风预防。缝线拆除时间取决于部位，基于专家意见和经验。
